A hemoglobin A1c blood test provides summarized information on blood glucose control over a 3 month period. This is the major reason for its popularity with endocrinologists and other diabetes practitioners, who do not have the time to review weeks of detailed daily blood glucose results. In healthy, non-diabetic patients, the hemoglobin A1c level is less than 5.5% of total hemoglobin, and long term studies have shown that the complications of diabetes can be delayed or even prevented if this level can be kept below 6.5%. Unlike fingerstick blood glucose tests that are readily performed by patients, the hemoglobin A1c level can only be measured in a reference laboratory or in the physician's office, making, availability an issue. Additionally, the hemoglobin A1c test can be misleading in certain medical circumstances and conditions as the test paradigm makes some assumptions that may occasionally reduce its accuracy in an evaluation of blood glucose control. Furthermore, even if the hemoglobin A1c blood test is made available to the patient for home use, this test will not replace home blood glucose monitoring, which is the only way to decide immediately whether the patient needs to modify his/her medications because of unforeseen glycemic excursions.
For home blood glucose monitoring, the control of blood glucose requires frequent fingerstick glucose testing. Typically a set of 4 to 8 tests or more per day is considered necessary for maintenance of good control for type 1 diabetes patients. Blood glucose monitors store time stamped test results and give running averages of the stored tests. The maximum amount of stored test results varies with the type of monitor, ranging from 30 data points to thousands. The running glucose average has some utility, but can be deceiving, especially for diabetes patients who suffer frequent wide swings of blood glucose from hypoglycemia (low blood glucose) to hyperglycemia (high blood glucose).
For example, if a blood glucose test is done during a hyperglycemic episode, with a blood glucose value of 190 mg/dl, followed by another glucose test during a hypoglycemia episode with a glucose value of 40 mg/dl, the 115 mg/dl average of these two tests may erroneously indicate reasonably good diabetes control and thereby, mislead the health care provider as well as the patient. Even more significantly, through a period of repeated highs and lows, the patient's diabetes may be completely out of control, and yet the average test value shown on the monitor may still be “normal.” Moreover, the computation of the average blood glucose value does not take into account the time dimension. Suppose that two tests are taken within a very short time frame showing near-identical results. When computing the average test value for a series of blood glucose results including the two similar results, these two values are effectively double counted, with a resulting averaging bias.
Frequently, when patients find blood glucose results outside the normal range, they repeat the blood, test immediately (to make sure that it was correct the first time), and a distorted running average is calculated by meter software. A high (or low) blood glucose situation lasting a long time will have a more significant impact on the patient's health than high or low glucose levels persisting for only a short time. So it is imperative to take into account the time elapsed between the tests, which a traditional running glucose average does not do. Thus, in spite of being the most common statistic reported on blood glucose monitors today, the average glucose calculation often supplies information of limited utility and may be downright misleading. In today's blood glucose meters, there is no statistical construct which offers a time-normalized “snapshot view” of glycemic control. Patients, physicians and health care managers need a more sophisticated statistical analysis of glycemic control in order to make informed decisions about diabetes management.